Summary
The New York Appellate Division, Third Department, affirmed a Workers’ Compensation Board decision finding insufficient evidence that the claimant committed material fraud under Workers’ Compensation Law § 114-a. The court held that the claimant’s admitted alcohol consumption had already been considered in determining compensability and that substantial evidence supported the Board’s conclusion that no compelling evidence of fraud warranted suspending benefits.
Topics
Practice areas
Questions Presented
- Whether substantial evidence supported the Workers' Compensation Board's determination that claimant did not commit a material fraud violation under Workers' Compensation Law § 114-a by testifying about when he last consumed alcohol before the accident.
- Whether the prior litigation of claimant's intoxication and the establishment of the claim precluded or substantially undermined the carrier's later request to litigate the alleged § 114-a violation.
Holdings
- Substantial evidence supported the Board's determination that there was no compelling evidence of material fraud sufficient to establish a Workers' Compensation Law § 114-a violation.
- Although establishment of a workers' compensation claim based on an intoxication issue does not categorically preclude a later § 114-a inquiry, the prior determination and claimant's admission here meant that the alleged fraud issue was essentially determined and did not warrant further litigation.
Key quotations
“Although compensability of a claim where intoxication is an issue does not necessarily preclude the possibility of a Workers' Compensation Law § 114-a violation, here, in light of claimant's admission during his hearing testimony that he had been drinking prior to the motor vehicle accident, we find that substantial evidence supports the Board's decision that there was no compelling evidence of material fraud to support a Workers' Compensation Law § 114-a violation, as such issue was essentially determined when, in crediting claimant's testimony and finding that intoxication was not the sole cause of the accident, the claim was established” (*2)
Factual background
Claimant was driving from his home in New Jersey to a work assignment in Buffalo when he was involved in a minor lane-change accident. While he was sitting in his vehicle after speaking with the other driver, a third vehicle struck his vehicle and caused serious injuries. Hospital testing showed a blood alcohol level of .18. During the initial workers' compensation proceedings, claimant admitted that he had consumed alcohol before the accident, and the claim was established because the carrier did not prove that intoxication was the sole cause of the accident.
Procedural history
After claimant was injured in a motor vehicle accident while traveling to a work assignment, a Workers' Compensation Law Judge established the claim and awarded benefits, finding that the carrier failed to establish that claimant's intoxication was the sole cause of the accident. The Board affirmed, and the Appellate Division previously affirmed the Board's decision. The carrier later sought further action based on a toxicology report and alleged that claimant committed fraud by misrepresenting when he last consumed alcohol. The WCLJ declined to entertain the § 114-a issue, and the Board affirmed, finding no compelling evidence of material fraud. The carrier appealed.